Prevalence Of Residents Research Articles

Evaluation of a financial incentive intervention on malaria prevalence among the residents in Lake Victoria basin, Kenya: study protocol for a cluster-randomized controlled trial

BackgroundIn the Lake Victoria basin of western Kenya, malaria remains highly endemic despite high coverage of interventions such as mass distribution of long-lasting insecticidal nets (LLIN), indoor residual spraying (IRS) programs, and improvement of availability and accessibility of rapid diagnostic tests (RDT) and artemisinin-based combination therapy (ACT) at community healthcare facilities. We hypothesize that one major cause of the residual transmission is the lack of motivation among residents for malaria prevention and early treatment.MethodsThis study will aim to develop a demand-side policy tool to encourage local residents’ active malaria prevention and early treatment-seeking behaviors. We examine the causal impact of a financial incentive intervention complemented with malaria education to residents in malaria-prone areas. A cluster-randomized controlled trial is designed to assess the effect of the financial incentive intervention on reducing malaria prevalence in residents of Suba South in Homa Bay County, Kenya. The intervention includes two components. The first component is the introduction of a financial incentive scheme tied to negative RDT results for malaria infection among the target population. This study is an attempt to promote behavioral changes in the residents by providing them with monetary incentives. The project has two different forms of incentive schemes. One is a conditional cash transfer (CCT) that offers a small reward (200 Ksh) for non-infected subjects during the follow-up survey, and the other is a lottery incentive scheme (LIS) that gives a lottery with a 10% chance of winning a large reward (2000 Ksh) instead of the small reward. The second component is a knowledge enhancement with animated tablet-based malaria educational material (EDU) developed by the research team. It complements the incentive scheme by providing the appropriate knowledge to the residents for malaria elimination. We evaluate the intervention’s impact on the residents’ malaria prevalence using a cluster-randomized control trial.DiscussionA policy tool to encourage active malaria prevention and early treatment to residents in Suba South, examined in this trial, may benefit other malaria-endemic counties and be incorporated as part of Kenya’s national malaria elimination strategy.Trial registrationUMIN000047728. Registered on 29th July 2022.

Exploratory study of risk factors related to SARS-CoV-2 prevalence in nursing homes in Flanders (Belgium) during the first wave of the COVID-19 pandemic.

In a previous study in Belgian nursing homes (NH) during the first wave of the COVID-19 pandemic, we found a SARS-CoV-2 seroprevalence of 17% with a large variability (0-45%) between NH. The current exploratory study aimed to identify nursing home-specific risk factors for high SARS-CoV-2 seroprevalence. Between October 19th, 2020 and November 13th, 2020, during the second COVID-19 wave in Belgium, capillary blood was collected on dried blood spots from 60 residents and staff in each of the 20 participating NH in Flanders and Brussels. The presence of SARS-CoV-2-specific IgG antibodies was assessed by ELISA. Risk factors were evaluated using a questionnaire, filled in by the director or manager of the NH. Assessed risk factors comprised community-related factors, resident-related factors, management and performance features as well as building-related aspects. The relation between risk factors and seroprevalence was assessed by applying random forest modelling, generalized linear models and Bayesian linear regression. The present analyses showed that the prevalence of residents with dementia, the scarcity of personal protective equipment (surgical masks, FFP2 masks, glasses and face shields), and inadequate PCR test capacity were related to a higher seroprevalence. Generally, our study put forward that the various aspects of infection prevention in NH require more attention and investment. This exploratory study suggests that the ratio of residents with dementia, the availability of test capacity and personal protective equipment may have played a role in the SARS-CoV-2 seroprevalence of NH, after the first wave. It underscores the importance of the availability of PPE and education in infection prevention. Moreover, investments may also yield benefits in the prevention of other respiratory infections (such as influenza).

Real-World Data about Commonly Used Antibiotics in Long-Term Care Homes in Australia from 2016 to 2019.

In this study, we use real-world data to explore trends in antibiotic use in a dynamic cohort of long-term care (LTC) residents. A cross-sectional retrospective analysis of pharmacy medication supply records of 3459 LTC residents was conducted from 31 May 2016 to 31 May 2019. The primary outcome was the monthly prevalence of residents with an antibiotic episode. Secondary outcomes were the type of antibiotic used and duration of use. Over the three-year study period, residents were supplied 10460 antibiotics. On average, 18.9% of residents received an antibiotic monthly. Antibiotic use decreased slightly over time with a mean of 168/1000 (95% CI 146-177) residents using at least one antibiotic per month in June 2016 to 148/1000 (95% CI 127-156) in May 2019. The total number of antibiotic days per 100 resident days remained relatively constant over the study period: 8.8 days in 2016-2017, 8.4 in 2017-2018 and 6.4 in 2018-2019. Prolonged durations exceeding 100 days were seen for a small percentage of residents. We found extensive antibiotic use, which is a recognized contributor to antimicrobial resistance development, underscoring the necessity for quality treatment guidelines in this vulnerable population.

Implementation of a centralized, web-based surveillance for healthcare associated infections among residents of long-term care facilities in Italy

ObjectiveThe Italian National Action Plan to contrast AMR identified among its objectives the development and implementation of a national Healthcare-Associated Infection (HAI) surveillance system based on European Centre for Disease Prevention and Control (ECDC) indications, through point prevalence surveys (PPS) of HAIs and antibiotic use in acute-care hospitals and long-term care facilities (LTCFs). We aimed to assess feasibility and appropriateness of proposed tools for a national surveillance system of HAIs and antibiotic use in LTCFs. Study designPoint prevalence survey. MethodsA pilot PPS was conducted between May–June 2022, among 15 LTCFs of 7 Italian regions. Data were collected in a single day in each LTCF, at the LTCF, ward, and resident levels, using a web-based data collection tool developed ad hoc. Data collector teams of each facility were invited to complete a questionnaire investigating opinions on the proposed tools. ResultsAmong 1025 included residents, the prevalence of residents with at least one HAI was 2.5% (95% CI 1.7%-3.7%) considering all HAIs and 2.2% (95% CI 1.3%–3%) without considering SARS-CoV-2 infections. The prevalence of antimicrobial use was 3% (95% CI 0.2%–4.3%). Overall, most respondents were satisfied with the web-based software, training and protocol, even though some difficulties were reported. ConclusionsA national surveillance network was established, which will facilitate future surveillance efforts. Further studies are necessary to evaluate the impact of the pandemic on HAI transmission and antibiotic use in LTCFs.

Diverse migratory portfolios drive inter‐annual switching behavior of elk across the Greater Yellowstone Ecosystem

AbstractA growing body of evidence shows that some ungulates alternate between migratory and nonmigratory behaviors over time. Yet it remains unclear whether such short‐term behavioral changes can help explain reported declines in ungulate migration worldwide, as opposed to long‐term demographic changes. Furthermore, advances in tracking technology reveal that a simple distinction between migration and nonmigration may not sufficiently describe all individual behaviors. To better understand the dynamics and drivers of ungulate switching behavior, we investigated 14 years of movement data from 361 elk in 20 herds across the Greater Yellowstone Ecosystem (GYE). First, we categorized yearly individual behaviors using a clustering algorithm that identified similar migratory tactics across a continuum of behaviors. Then, we tested seven hypotheses to explain why some ungulates switch behaviors, and we evaluated how behavioral changes affected the proportions of different behaviors across the system. We identified four distinct behavioral tactics: residents (4.8% of elk‐years), short‐distance migrants (53.7%), elevational migrants (21.9%) and long‐distance migrants (19.6%). Of the 20 herds, 18 were partially migratory, and 5 had all four movement tactics present. We observed switches between migratory tactics in all sets of consecutive years during our study period, with an average of 22.5% of individual elk changing movement tactics from one year to the next. Elk in herds with higher movement tactic diversity were significantly more likely to switch tactics and often responded more effectively to adverse environmental conditions, compared to those in herds with low movement tactic diversity. During our study period, switching increased the prevalence of both short‐ and long‐distance migrants, decreased the prevalence of elevational migrants, and had no effect on the prevalence of residents. Our findings suggest that rather than contributing to the declining migratory behavior found in the GYE, switching behavior may enable greater resiliency to continuously changing environmental and anthropogenic conditions.

Prevalence of and risk factors for Human Immunodeficiency Virus (HIV) infection in entrants and residents of an Ethiopian prison.

Prisoners generally have a higher prevalence of HIV infection compared to the general population from which they come. Whether this higher prevalence reflects a higher HIV prevalence in those entering prisons or intramural transmission of HIV within prisons or both is unclear. Any of these possibilities would increase the prevalence found in resident prisoners above that in the general population. Moreover, comparisons of HIV prevalence in entrants and residents and in men and women in African prisons are not well documented. The purpose of this study was to estimate and compare the prevalence and risk factors for HIV infection amongst both male as well as female and entrant and resident prisoners in a large Ethiopian Federal Prison. We studied consenting prisoners cross-sectionally from August 2014 through November 2016. Prison entrants were screened continuously for HIV infection and its associated risk factors and residents were screened in two waves one year apart. HIV was diagnosed at the prison hospital laboratory based on the Ethiopian national HIV rapid antibody testing protocol. An external, internationally-accredited reference laboratory confirmed results. Agreement of results between the laboratories were assessed. A total of 10,778 participants were screened for HIV. Most participants were young (median age of 26 years, IQR: 21-33), male (84%), single (61%), literate (89%), and urban residents (91%) without prior incarceration (96%). Prevalence of HIV was 3.4% overall. Rates of HIV (p = 0.80) were similar in residents and entrants in wave 1 and in entrants in both waves, but were 1.9-fold higher (5.4% vs 2.8%) in residents than entrants in wave 2 (both p<0.001). At entrance to the prison women were more likely to be HIV+ than men (5.5% in women vs 2.5% in men, p< 0.001). In contrast resident women were less likely to be HIV+, but this difference was not statistically significant (3.2% in women vs 4.3% in men, p = 0.125). Other risk factors associated with HIV infection were increasing age (p<0.001), female gender (p<0.001), marital status (never vs other categories, p = 0.016), smaller number of rooms in their houses pre-imprisonment (p = 0.031), TB diagnosis ever (p<0.001), number of lifetime sex partners (especially having 2-10, p<0.001), and genital ulcer (p = 0.037). Prevalence of HIV in the residents at this large, central Ethiopian prison was higher than that estimated for the general population and lower than in many other studies from other smaller Ethiopian prisons. A higher prevalence in residents than in entrants were found only in our second wave of screening after one year of continuous screening and treatment, possibly representing increased willingness of residents at increased risk of HIV to participate in the second wave. Thus, this findings did not clearly support intramural transmission of HIV or the effectiveness of screening to reduce prevalence. Finally, the higher HIV prevalence in women than men requires that they be similarly screened and treated for HIV infection.

0238 Perceived Childhood Neighborhood Safety and Sleep Health during Adulthood

Abstract Introduction Neighborhood safety has been cross-sectionally associated with sleep health at different life stages. However, few studies have investigated childhood neighborhood safety and adulthood sleep despite the possibility that childhood neighborhood safety may serve as a modifiable target for primordial prevention of poor sleep health. Methods Using data from 1,611 Black/African-American women enrolled in the Study of Environment, Lifestyle and Fibroids, we investigated associations between perceived childhood neighborhood safety and adulthood sleep. Participants reported safety of their childhood neighborhoods as unsafe vs. safe at ages 5,10, and 15 years. Participants also self-reported current (ages 23-35 years) sleep duration and quality (i.e., frequently wake feeling unrested [≥4 days/week] and frequent insomnia symptoms [≥15 days/month of difficulty falling or staying asleep]). Adjusting for childhood socioeconomic characteristics, log binomial models estimated prevalence ratios (PRs) and 95% confidence intervals (CIs). For perceived safety at ages 10 and 15 years, we applied inverse probability weights to models to adjust for perceived neighborhood safety at prior ages. Results Mean age ± standard deviation was 29 ± 3.5 years. Prevalence of residence in a childhood neighborhood perceived as unsafe increased with age (Age 5- 20%, Age 10- 22%, Age 15- 31%), and 17% reported an unsafe neighborhood at every age. Both short sleep duration (&amp;lt;7 hours) and frequently waking feeling unrested during adulthood were reported by approximately 60% of women, and 10% reported frequent insomnia symptoms. Participants in perceived unsafe vs. safe neighborhoods at every age were more likely to frequently wake feeling unrested as adults (PR=1.12 [95% CI: 1.00-1.25]). Perceived unsafe neighborhood at ages 5 and 15 years was associated with frequent insomnia symptoms and frequently waking feeling unrested, respectively. Perceived unsafe neighborhood at age 10 years was marginally associated with a higher prevalence of both frequently waking feeling unrested (PR=1.11 [0.98-1.27]) and frequent insomnia symptoms (PR=1.58 [0.99-2.52]) during adulthood. Conclusion Perceived unsafe neighborhood during childhood was associated with poorer sleep during adulthood among a cohort of young Black women. Support (If Any) Division of Intramural Research, National Institutes of Health (NIH), National Institute of Environmental Health Sciences (Z1AES103325[CLJ] and 1ZIAES049013[DB]), and the American Recovery and Reinvestment Act funds designated for NIH research

Determinantes sociales, clínicos y psicosociales asociados a hipertensión arterial no controlada en adultos mayores. Encuesta SABE Colombia 2016

ObjectiveTo evaluate sociodemographic, clinical and psychosocial characteristics that are associated with uncontrolled arterial hypertension (HANC) in older adults in Colombia. MethodsSecondary analysis of data from the National Survey of Health, Welfare and Aging (SABE Colombia 2016), in which men and women aged 60 years or older in the country who were not institutionalized were interviewed. The dependent variable was uncontrolled hypertension (HANC) (≥140/90mm Hg). The SABE survey surveyed 23694 older adults; 11264 had a diagnosis of arterial hypertension (HTA) and were taking antihypertensive medication. On the other hand, 5106 older adults, randomly selected, had their blood pressure taken. Participants previously diagnosed with HTA under medical management with antihypertensives and who had had their blood pressure taken at the same time were included, resulting in a sample of 2656 participants. Sociodemographic, clinical and psychosocial characteristics were evaluated. Univariate, bivariate, and multivariate analyzes with logistic regression were performed. ResultsOne thousand one hundred eighty-eight (44.7%) participants presented HANC. A higher prevalence of HANC was observed in adults older than 74 years (OR 1.31; 95% CI 1.09-1.57) and lower prevalence in residents of urban areas (OR 0.55; 95% CI 0.42–0.71). ConclusionsAge over 74 years and living in a rural area were identified as variables associated with inadequate blood pressure control in non-institutionalized older adults in Colombia.

Elderly People from Old Age Homes have Higher Risk of Malnutrition and Depression as Compared to Family Setup

With increase in average age of population and increasing trend of nuclear families, old age homes are fast becoming a norm in India. The COVID-19 pandemic has made nutritionists revisit the health status of our elderly living in different family set ups. The present study was carried out with the objective to compare the health and risk of malnutrition among elderly (? 60 yrs in age) living in three different residential set ups i.e. old age homes, urban family or rural family. The study was carried out in Hisar district of Haryana state in Northern India. In this cross-sectional study, sixty subjects each (N=180) from the three residential set ups were selected randomly and assessed for depression, level of independence in daily activities and risk for malnutrition. Standard scales viz. Geriatric Depression Scale, Barthel Index and Mini Nutritional Assessment Scale were used. The PAR (Physical Activity Ratio) values for activities performed in a day were aggregated over the period i.e. 24 hours to yield physical activity level. It was observed that respondents from rural family set up were more active as compared to their counterparts in urban family set up or old age homes. Osteoporosis (94.44%), joint pain (87.78%), loss of appetite (85.56%) and anemia (80.56%) were the most commonly reported problems. Per cent prevalence of most problems was higher in old age home respondents. The level of independence for most activities was lowest in old age home respondents as compared to other two residential set ups. Depression was evident in 36.67 per cent of total respondents with higher per cent prevalence in residents of old age home. It may be concluded that elderly people from old age homes have higher risk of malnutrition and depression as compared to urban or rural family setup. Interventions are highly recommended for mental and nutritional well-being of elderly specially those living in old age homes. Considering the increasing trend of old age homes, deeper studies are required on their living conditions. There should be stringent SOP’s for all old age homes and elderly care.

Healthcare-associated infections and antimicrobial use in Belgian nursing homes: results of three point prevalence surveys between 2010 and 2016

BackgroundBelgium monitors the burden of healthcare-associated infections (HAIs) and antimicrobial use in nursing homes (NHs) by participating in the European point prevalence surveys (PPSs) organised in long-term care facilities (HALT surveys). We present the main findings of the three national PPSs conducted in NHs participating in at least one of these surveys, and in a cohort that participated in all three consecutive surveys.MethodsAll NHs were invited to voluntarily participate and conduct the survey on one single day in May-September 2010 (HALT-1), in April-May 2013 (HALT-2) or in September-November 2016 (HALT-3). Data were collected at institutional, ward and resident level. A detailed questionnaire had to be completed for all eligible (i.e. living full time in the facility since at least 24 h, present at 8:00 am and willing to participate) residents receiving at least one systemic antimicrobial agent and/or presenting at least one active HAI on the PPS day. The onset of signs/symptoms had to occur more than 48 h after the resident was (re-)admitted to the NH.ResultsA total of 107, 87 and 158 NHs conducted the HALT-1, HALT-2 and HALT-3 survey, respectively. The median prevalence of residents with antimicrobial agent(s) increased from 4.3% (95% confidence interval (CI): 3.5-4.8%) in HALT-1 to 4.7% (95% CI: 3.5-6.5%) in HALT-2 and 5.0% (95% CI: 4.2-5.9%) in HALT-3. The median prevalence of residents with HAI(s) varied from 1.8% (95% CI: 1.4-2.7%) in HALT-1 to 3.2% (95% CI: 2.2-4.2%) in HALT-2 and 2.7% (95% CI: 2.1-3.4%) in HALT-3. Our post-hoc analysis on the cohort (n = 25 NHs) found similar trends. In all three surveys, respiratory tract infections were most frequently reported, followed by skin/wound infections in HALT-1 and urinary tract infections in HALT-2 and HALT-3. Antimicrobials were most commonly prescribed for the therapeutic treatment of an infection: 66.4% in HALT-1, 60.9% in HALT-2 and 64.1% in HALT-3. Uroprophylaxis accounted for 28.7%, 35.6% and 28.4% of all prescriptions, respectively.ConclusionsNone withstanding the limitations peculiar to the study design, the PPSs enabled us to assess the occurrence of and to increase awareness for HAIs and rational antimicrobial use in NHs at both local and national level.

Reduction of admissions for urgent and elective pacemaker implant during the COVID-19 outbreak in Northern Italy.

The coronavirus disease-19 (COVID-19) outbreak has been recently associated with lower hospitalization rates for acute coronary syndromes. Aim of the study was to investigate whether a similar behaviour is observed in admissions for urgent pacemaker implant. This retrospective study included 1315 patients from 18 hospitals in Northern Italy with a high number of COVID-19 cases. Hospitalization rates for urgent pacemaker implant were compared between the following periods: 20 February to 20 April 2020 (case period); from 1 January to 19 February 2020 (intra-year control period); from 20 February to 20 April 2019 (inter-year control period). The incidence rate of urgent implants was 5.0/day in the case period, 6.0/day in the intra-year control period and 5.8/day in the inter-year control period. Incidence rate in the case period was significantly lower than both the intra-year [incidence rate ratio (IRR): 0.81, 95% CI 0.67-0.99, P = 0.040] and inter-year control periods (IRR: 0.79, 95% CI 0.66-0.95, P = 0.012); this reduction was highest after the national lockdown (IRR 0.68, 95% CI 0.52-0.91, P = 0.009). The prevalence of residents in rural areas undergoing urgent pacemaker implant was lower in the case period (36%) than in both the intra-year (47%, P = 0.03) and inter-year control periods (51%, P = 0.002). Elective pacemaker implants also decreased in the case period, with the incidence rate here being 3.5/day vs. 6.4/day in the intra-year (-45%) and 6.9/day in the inter-year period (-49%). Despite severe clinical patterns, the COVID-19 outbreak has negatively affected the population presentation to Emergency Departments for bradyarrhythmias requiring urgent pacemaker implant in Northern Italy. This mainly occurred after the national lockdown and concerned patients living in rural areas.

The Use of Email and Secure Messaging between Residents and Patients at St. Michael’s Family Medicine Residency Program

Background: The use of email and secure messaging between physicians and patients is increasing in frequency. P PHowever, residents lack formal training in e-communication, patient privacy and other confidentiality issues associated with it. There is also a paucity of assessment tools and faculty feedback regarding this practice.Objective: The objective is to investigate use of email and secure messaging between patients and residents at St. Michael’s family medicine residency program and analyze educational constructs, facilitators, and barriers relevant to this practice.Methods: Three cross-sectional surveys were conducted at St. Michael’s family medicine residency program in 2018-2020. Each resident in postgraduate year 1 &amp; 2 received an email inviting them to respond.&#x0D; Results: The prevalence of residents using email or secure messaging is increasing (47% in 2018 vs 81% in 2020). Over 86% of FM residents used hospital/clinic computers in 2020 but the proportion of residents using personal computers rose to 60% that year. A prominent barrier appears to be the ‘potential for inappropriate use by patients’, which was cited as ‘fairly’ or ‘very’ important at rates of 85.3%, 86.9%, and 73.68% in 2018, 2019 and 2020, respectively. 76.4% and 56.52% of residents cited lack of consistent advice/guidelines as a barrier in the years 2018 and 2019, respectively. The perception of support has risen (33.3% residents reporting supervisors as ‘very’ or ‘somewhat’ supportive versus 57.8% in 2020). The majority reported ‘rarely’ or ‘never’ getting feedback/guidance from their supervisors.Conclusions: Our study found an increase in the use of email and secure messaging. Residents are increasingly using their personal computers which likely reflects the increase in virtual models of care. Residents have concerns regarding the appropriate use of such messaging by patients. Lack of supervision may pose a risk of patient confidentiality/privacy breach. There is a need for curricular re-design and faculty development around this practice.

Bewohner*innen mit Parkinson-Syndrom in der stationären Altenhilfe

HintergrundParkinson-Syndrome führen im Krankheitsverlauf zur Pflegebedürftigkeit bei den Betroffenen. Zur Prävalenz der Bewohner*innen mit einem Parkinson-Syndrom in Pflegeeinrichtungen, zu ihrer Versorgungssituation und zur vorhandenen Expertise der Pflegefachpersonen in den Einrichtungen ist wenig bekannt.Ziel der ArbeitDie vorliegende Studie untersucht die Prävalenzrate der Bewohner*innen mit einem Parkinson-Syndrom in stationären Pflegeeinrichtungen in Deutschland. Die Arbeit exploriert die Zusammenarbeit verschiedener Akteure, deren Koordination sowie Information und Wissen des Pflegepersonals. Ziel ist es, einen möglichen Bedarf an spezialisierter Pflege in Pflegeeinrichtungen aufzuzeigen.MethodeDie schriftliche Querschnittsbefragung der Wohnbereichsleitungen von 500 zufällig ausgewählten Pflegeeinrichtungen in Deutschland erfolgte von Januar bis Juni 2020. Der eingesetzte Fragebogen wurde vorab literaturbasiert entwickelt. Die Daten wurden deskriptiv analysiert.ErgebnisseAus 57 Einrichtungen wurden Fragebogen von 85 Wohnbereichen analysiert (Rücklaufquote 11,4 %). Die Prävalenzrate von Bewohner*innen mit einem Parkinson-Syndrom in der stationären Altenhilfe beträgt 13,9 %. Mehr als die Hälfte haben zusätzlich eine Demenzdiagnose (52,8 %). In 26 % der Fälle erfolgen Krankenhausaufenthalte infolge von Sturzereignissen. Eine eindeutige Koordination der Versorgung durch ärztliche oder pflegerische Spezialisten gibt es nicht.DiskussionBewohner*innen mit einem Parkinson-Syndrom in der stationären Altenhilfe sind häufig, und sie zeigen komplexe motorische und nichtmotorische Symptome – auch durch die Komorbidität Demenz. Die Häufigkeit von Sturzereignissen mit Krankenhausaufenthalten und die geringe Anzahl Parkinson-Syndrom-spezifischer Hilfsmittel zeigen, dass das Wissen der Pflege vor Ort gesteigert werden kann. Eine zentrale Koordination und Unterstützung hierzu sollten in der stationären Langzeitpflege etabliert werden.Zusatzmaterial onlineZusätzliche Informationen sind in der Online-Version dieses Artikels (10.1007/s00391-021-01874-y) enthalten.

Trends in Prescribing of Antibiotics and Drugs Investigated for Coronavirus Disease 2019 (COVID-19) Treatment in US Nursing Home Residents During the COVID-19 Pandemic.

BackgroundTrends in prescribing for nursing home (NH) residents, which may have been influenced by the COVID-19 pandemic, have not been characterized.MethodsLong-term care pharmacy data from 1,944 U.S. NHs were used to evaluate trends in prescribing of antibiotics and drugs that were investigated for COVID-19 treatment, including hydroxychloroquine, famotidine, and dexamethasone. To account for seasonal variability in antibiotic prescribing and decreased NH occupancy during the pandemic, monthly prevalence of residents with a prescription dispensed per 1,000 residents serviced was calculated from January – October and compared as relative percent change from 2019 to 2020.ResultsIn April 2020, prescribing was significantly higher in NHs for drugs investigated for COVID-19 treatment than 2019; including hydroxychloroquine (+563%, 95% confidence interval (CI) 5.87, 7.48) and azithromycin (+150%, 95% CI 2.37, 2.63). Ceftriaxone prescribing also increased (+43%, 95% CI 1.34, 1.54). Prescribing of dexamethasone was 36% lower in April (95% CI 0.55, 0.73) and 303% higher in July (95% CI 3.66, 4.45). Although azithromycin and ceftriaxone prescribing increased, total antibiotic prescribing among residents was lower from May (-5%, 95% CI 0.94, 0.97) through October (-4%, 95% CI 0.94, 0.97) in 2020 compared to 2019.ConclusionsDuring the pandemic, large numbers of residents were prescribed drugs investigated for COVID-19 treatment, and an increase in prescribing of antibiotics commonly used for respiratory infections was observed. Prescribing of these drugs may increase the risk of adverse events, without providing clear benefits. Surveillance of NH prescribing practices is critical to evaluate concordance with guideline-recommended therapy and improve resident safety.

The Prevalence of Disability Health Training and Residents With Disabilities in Emergency Medicine Residency Programs.

Individuals with disabilities experience significant health care disparities due to a multitude of barriers to effective care, which include a lack of adequate physician training on this topic and negative attitudes of physicians. This results in disparities through inadequate physical examination and diagnostic testing, withholding or inferior treatment, and neglecting preventative care. While much has been published about disability education in undergraduate medical education, little is known about the current state of disability education in emergency medicine (EM) residency programs. In 2019, a total of 237 EM residency program directors (PDs) in the United States were surveyed about the actual and desired number of hours of disability health instruction, perceived barriers to disability health education, prevalence of residents and faculty with disabilities, and confidence in providing accommodations to residents with disabilities. A total of 104 surveys were completed (104/237, 43.9% response rate); 43% of respondents included disability-specific content in their residency curricula for an average of 1.5 total hours annually, in contrast to average desired hours of 4.16 hours. Reported barriers to disability health education included lack of time and lack of faculty expertise. A minority of residency programs have faculty members (13.5%) or residents (26%) with disabilities. The prevalence of EM residents with disabilities was 4.02%. Programs with residents with disabilities reported more hours devoted to disability curricula (5 hours vs 1.54hours, p=0.017) and increased confidence in providing workplace accommodations for certain disabilities including mobility disability (p=0.002), chronic health conditions (p=0.022), and psychological disabilities (p=0.018). A minority of EM PDs in our study included disability health content in their residency curricula. The presence of faculty and residents with disabilities is associated with positive effects on training programs, including a greater number of hours devoted to disability health education and greater confidence in accommodating learners with disabilities. To reduce health care disparities for patients with disabilities, we recommend that a dedicated disability health curriculum be integrated into all aspects of the EM residency curriculum, including lectures, journal clubs, and simulations and include direct interaction with individuals with disabilities. We further recommend that disability be recognized as an aspect of diversity when hiring faculty and recruiting residents to EM programs, to address this training gap and to promote a diverse and inclusive learning environment.

Prescription analgesia and adjuvant use by pain severity at admission among nursing home residents with non-malignant pain

ObjectiveWe estimated the use of prescribed analgesics and adjuvants among nursing home residents without cancer who reported pain at their admission assessment, in relation to resident-reported pain severity.MethodsMedicare Part D claims were used to define 3 classes of analgesics and 7 classes of potential adjuvants on the 21st day after nursing home admission (or the day of discharge for residents discharged before that date) among 180,780 residents with complete information admitted between January 1, 2011 and December 9, 2016, with no cancer diagnosis.ResultsOf these residents, 27.9% reported mild pain, 46.6% moderate pain, and 25.6% reported severe pain. The prevalence of residents in pain without Part D claims for prescribed analgesic and/or adjuvant medications was 47.3% among those reporting mild pain, 35.7% among those with moderate pain, and 24.8% among those in severe pain. Among residents reporting severe pain, 33% of those ≥ 85 years of age and 35% of those moderately cognitively impaired received no prescription analgesics/adjuvants. Use of all classes of prescribed analgesics and adjuvants increased with resident-reported pain severity, and the concomitant use of medications from multiple classes was common.ConclusionAmong nursing home residents with recognized pain, opportunities to improve the pharmacologic management of pain, especially among older residents, and those living with cognitive impairments exist.

Changes in Long-Term Care Markets: Assisted Living Supply and the Prevalence of Low-Care Residents in Nursing Homes

ObjectivesTo assess the effect of changes in assisted living (AL) capacity within a market on prevalence of residents with low care needs in nursing homes. DesignRetrospective, longitudinal analysis of nursing home markets. Setting and participantsTwelve thousand two hundred fifity-one nursing homes in operation during 2007 and 2014. MeasurementsWe analyzed the percentage of residents in a nursing home who qualified as low-care. For each nursing home, we constructed a market consisting of AL communities, Medicare beneficiaries, and competing nursing homes within a 15-mile radius. We estimated the effect of change in AL beds on prevalence of low-care residents using multivariate linear models with year and nursing home fixed effects. ResultsThe supply of AL beds increased by an average 258 beds per nursing home market (standard deviation = 591) during the study period. The prevalence of low-care residents decreased from an average of 13.0% (median 10.5%) to 12.2% (median 9.5%). In adjusted models, a 100-bed increase in AL supply was associated with a decrease in low-care residents of 0.041 percentage points (P = .026), controlling for changes in market and nursing home characteristics, county demographics, and year and nursing home fixed effects. In markets with a high percentage of its Medicare beneficiaries (≥14%) dual eligible for Medicaid, the effect of AL is stronger, with a 0.066–percentage point decrease per 100 AL beds (P = .026) vs a 0.016–percentage point decrease in low-duals markets (P = .48). Conclusions and implicationsOur analysis suggests that some of the growth in AL capacity serves as a substitute for nursing homes for patients with low care needs. Furthermore, the effects are concentrated in markets with an above-average proportion of beneficiaries with dual Medicaid eligibility.

Bacteriologically-confirmed pulmonary tuberculosis in an Ethiopian prison: Prevalence from screening of entrant and resident prisoners.

BackgroundPulmonary Tuberculosis (PTB) is a major health problem in prisons. Multiple studies of TB in regional Ethiopian prisons have assessed prevalence and risk factors but have not examined recently implemented screening programs for TB in prisons. This study compares bacteriologically-confirmed PTB (BC-PTB) prevalence in prison entrants versus residents and identifies risk factors for PTB in Kality prison, a large federal Ethiopian prison located in Addis Ababa, through a study of an enhanced TB screening program.MethodsParticipating prisoners (n = 13,803) consisted of 8,228 entrants screened continuously and 5,575 residents screened in two cross-sectional waves for PTB symptoms, demographics, TB risk factors, and medical history. Participants reporting at least one symptom of PTB were asked to produce sputum which was examined by microscopy for acid-fast bacilli, Xpert MTB/RIF assay and MGIT liquid culture. Prevalence of BC-PTB, defined as evidence of Mycobacterium tuberculosis (MTB) in sputum by the above methods, was compared in entrants and residents for the study. Descriptive analysis of prevalence was followed by bivariate and multivariate analyses of risk factors.ResultsPrisoners were mainly male (86%), young (median age 26 years) and literate (89%). Prevalence of TB symptoms by screening was 17% (2,334/13,803) with rates in residents >5-fold higher than entrants. Prevalence of BC-PTB detected by screening in participating prisoners was 0.16% (22/13,803). Prevalence in residents increased in the second resident screening compared to the first (R1 = 0.10% and R2 = 0.39%, p = 0.027), but remained higher than in entrants (4.3-fold higher during R1 and 3.1-fold higher during R2). Drug resistance (DR) was found in 38% (5/13) of culture-isolated MTB. Risk factors including being ever diagnosed with TB, history of TB contact and low Body Mass Index (BMI) (<18.5) were significantly associated with BC-PTB (p<0.05).ConclusionsBC-PTB prevalence was strikingly lower than previously reported from other Ethiopian prisons. PTB appears to be transmitted within this prison based on its higher prevalence in residents than in entrants. Whether a sustained program of PTB screening of entrants and/or residents reduces prevalence of PTB in prisons is not clear from this study, but our findings suggest that resources should be prioritized to resident, rather than entrant, screening due to higher BC-PTB prevalence. Detection of multi- and mono-DR TB in both entrant and resident prisoners warrants regular screening for active TB and adoption of methods to detect drug resistance.

Role of socio-economic status in the relationship between air pollution and health

OPS 60: Social factors and environmental health across the world, Room 210, Floor 2, August 27, 2019, 1:30 PM - 3:00 PM Background/aims: Inequalities in air pollution exposure and relative health impacts are a relevant aspect in epidemiological research and policy. Aim of the study was to investigate the role of deprivation in the association between air pollution and mortality in a large Italian cohort. Methods: The Supersito project analyzed the effects of aerosols on health in an Italian cohort (aged 30+) of residents in a highly polluted area of Northern Italy. Three years daily measurements (2012-2014) of PM2.5 and its components were made in 4 sites. Monitoring and modeling approach were used to assign a spatio-temporal exposure to each subject’s home address. Natural and cause-specific mortality were analyzed in relation to PM2.5 in the period 2009-2013, using Cox regression models (age of subjects as temporal axis), adjusting for education, citizenship, sex and residence area (urban, coastal, rural), and stratifying for a Deprivation Index (DI) calculated at census-block level and categorzed by quintiles of population at a regional level. Results: 6,011,667 person-years were observed. Total mortality shows an increasing trend in the crude rate related to DI quintiles. The cohort characteristics (gender, age, level of exposure to PM2.5) are homogeneous in the 5 sub-groups, with a prevalence of residence in urban area for less deprived and coastal area for most deprived. Natural mortality reported a 7% increase in risk for increases of 10 □g/m3 of PM2.5 on the whole cohort, but the increase was much higher in most compared to the least deprived [HR=1.014 (95%CI:0.93-1.10), 1.0015 (95%CI:0.93-1.10), 1.022 (95%CI:0.93-1.11), 1.08 (95%CI:1.00-1.16), 1.18 (95%CI:1.11-1.25), respectively]. Conclusions: Stratified analysis revealed increasing associations between PM2.5 and mortality for those living in most deprived small areas. Both PM2.5 and deprivation have been measured at residence, therefore we cannot disentangle if deprivation acts at the individual or context level in increasing the effect of air pollution on mortality.

MON-336 LONGITUDINAL ANALYIS OF KIDNEY FUNCTION AND POSSIBLE FACTORS INVOLVED AFTER THE GREAT EAST JAPAN EARTHQUAKE AMONG RESIDENTS NEAR THE FUKUSHIMA DAIICHI NUCLEAR POWER PLANT

In March 2011, the Great East Japan Earthquake and subsequent tsunami seriously damaged the northeast Japanese Pacific coast, including a level 7 accident at the Fukushima Daiichi Nuclear Power Plant (FDNPP). Thousands of residents of Futaba District (where FDNPP is located) evacuated because of possible radioactive contamination. Seven years after the accident, evacuated residents are coming back to Futaba District due to the decreased exposure to radioactivity. The long-term effects of the Great East Japan Earthquake and the FDNPP accident on the kidney function of residents of Futaba District remained unknown. We performed yearly medical examinations of Futaba District residents aged ≥40 years from 2011 to 2016. Approximately 15,000 residents underwent the medical examination every year. Of these, 4,712 had evacuated the district after the Earthquake. The prevalence of hypertension defined as systolic blood pressure >140 mmHg was more than 40% in the days right after the Earthquake, and the prevalence gradually decreased to less than 30% in 2014. The prevalence thereafter increased again over the next 2 years. The prevalence of glycosuria showed a pattern similar to that of hypertension. The prevalence of residents with HbA1c >6.0% and the mean uric acid level increased throughout the 6-year examination. The prevalence of proteinuria remained unchanged, while that of hematuria slightly decreased. The mean creatine and estimated glomerular filtration rate values showed no specific alteration tendency, but the prevalence of chronic kidney disease (CKD) stage G3 or worse kept increasing throughout the 6-year examination. Interestingly, the individuals who evacuated were associated with a significantly higher risk of a new onset of CKD stage G3 or worse compared to the residents who never evacuated, even after the adjustment of background factors. Various factors including psychological stress by the disaster itself, psychological stress due to life as an evacuee, and the decreased amount of outdoor activity were likely to be associated with the changes in the health condition of the inhabitants of Futaba District. Those factors are also likely to have slight but significant influences on kidney function. Our analyses identified no factors that appeared to be directly affected by radiation exposure